Diabetes-associated dermatological manifestations in primary care and their association with vascular complications

Jean-Eudes Trihan; Damien Lanéelle; Neil Metcalfe; Antonia Perez Martin; Pierre Frances

doi:10.1007/s40200-020-00594-1

Diabetes-associated dermatological manifestations in primary care and their association with vascular complications

J Diabetes Metab Disord. 2020 Sep 16;19(2):989-996. doi: 10.1007/s40200-020-00594-1. eCollection 2020 Dec.

Authors

Jean-Eudes Trihan¹, Damien Lanéelle², Neil Metcalfe³, Antonia Perez Martin⁴, Pierre Frances⁵

Affiliations

¹ Vascular Medicine Department, University Hospital, 86000 Poitiers, France.
² Vascular Medicine Department, University Hospital, 14000 Caen, France.
³ General Practice, York, YO UK.
⁴ Vascular Medicine Department, University Hospital, 30000 Nîmes, France.
⁵ General Practice, 66650 Banuyls-sur-Mer, France.

Abstract

Introduction: Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications.

Methods: Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD).

Results: 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001).

Conclusion: In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.

Keywords: Dermatological manifestations; Diabetes mellitus; Diabetic dermopathy; Necrobiosis lipoidica diabeticorum; Primary care; Vascular complications.